Clinical, Laboratory, Histological, Radiological, and Metabolic Features and Prognosis of Malignant Pleural Mesothelioma

Our plain-English summary of Clinical, Laboratory, Histological, Radiological, and Metabolic Features and Prognosis of Malignant Pleural Mesothelioma, by Y. Zhang, R. Li, Y. Gu, et al (Medicina, 2022).

The study

• Authors: Y. Zhang, R. Li, Y. Gu, Y. LiZhu, X. Liu, S. Zhang
• Journal: Medicina
• Published: 2022;58(12)
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is an aggressive and rare malignant pleural tumor. Methods: MPM patients diagnosed in Beijing Chaoyang Hospital and Beijing Tongren Hospital were the focus of this study. We collected and analyzed the histological, radiological, and metabolic features of MPM patients. At the same time, Cox univariable and multivariable analyses were used to explore the laboratory risk factors affecting the prognosis of MPM patients. Results: A total of 129 MPM patients were included in this study. MPM includes three main histological subtypes: epithelioid, sarcomatoid and biphasic. Among them, epithelial subtypes accounted for the highest proportion. Calretinin, Wilms' tumor gene (WT1), cytokeratin 5/6 (CK5/6), and D2-40 were the most useful mesothelial markers to support a MPM diagnosis. The imaging features of MPM patients are pleural thickening and pleural effusion. In PET-CT, the affected pleura showed obvious high uptake of tracer, and the degree was related to the specific subtype. The median follow-up time was 55.0 (30.0, 94.0) months. A total of 92 (71.3%) patients died during follow-up. The median survival time of patients was 21.0 (9.0, 48.0) months. The Cox multivariable analysis showed that age [hazard ratio (HR), 1.824; 95% confidence interval (CI) 1.159-2.872; p = 0.009; uncorrected], ESR (HR, 2.197; 95% CI 1.318-3.664; p = 0.003; with Bonferroni correction), lymphocytes (HR, 0.436; 95% CI 0.258-0.737; p = 0.002; with Bonferroni correction), platelets (HR, 1.802; 95% CI 1.084-2.997; p = 0.023; uncorrected) and total protein (HR, 0.625; 95% CI 0.394-0.990; p = 0.045; uncorrected) were independent risk factors for prognosis, after adjusting for confounding factors. Conclusions: Age, ESR, lymphocytes, platelets and total protein may be related to the prognosis of MPM patients. Summarizing the histological, radiological, and metabolic features of MPM patients in the two centers can increase clinicians' understanding of this rare tumor.

In plain English

This was a retrospective study of 129 adults with malignant pleural mesothelioma diagnosed at two Beijing hospitals, Chaoyang and Tongren, between January 2010 and May 2022. The authors described tissue, CT and PET-CT findings and tested which blood results at diagnosis were linked with survival. Of the 129 patients, 27 (20.9%) had a clear history of asbestos exposure. Fiber types were not reported. Asbestos exposure was not statistically significantly associated with survival (hazard ratio 0.979, 95% CI 0.599–1.599). The epithelioid subtype was the most common. During a median follow-up of 55.0 months, 92 patients (71.3%) died, and median survival was 21.0 months. After adjustment, an ESR above 20.5 mm/h was linked with shorter survival (HR 2.197, 95% CI 1.318–3.664). A lymphocyte count above 1.1 × 10^9 per litre was linked with longer survival (HR 0.436, 95% CI 0.258–0.737). Both met the authors' stricter statistical threshold. Links for age, platelets and total protein were exploratory. CT features did not differ significantly by subtype, and only six patients had PET-CT. The authors concluded these factors "may be related" to prognosis, and noted a small sample and possible selection bias.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective observational cohort study at two hospitals
• Who was studied: 129 patients aged over 18 with pathologically proven malignant pleural mesothelioma, diagnosed and treated at Beijing Chaoyang Hospital and Beijing Tongren Hospital, China, January 2010 to May 2022. 71 were male and 58 female, with a median age of 65.5 years.
• Exposure: Asbestos exposure history was recorded from medical records as yes or no. 27 of 129 patients (20.9%) had a clear history. No fiber types, products, jobs or doses were reported. The study's main focus was blood test results at diagnosis, such as ESR, lymphocytes, platelets and total protein, in relation to survival.
• Main results:
  • Over a median follow-up of 55.0 months, 92 of the 129 patients (71.3%) died.
  • Median survival for all patients was 21.0 months (interquartile range 9.0 to 48.0).
  • In univariable analysis, patients with an asbestos exposure history (27) compared with those without (102) had a hazard ratio of 0.979 (95% CI 0.599–1.599, p = 0.931). This was not statistically significant, and asbestos exposure was not included in the multivariable model.
  • In the multivariable analysis, ESR above 20.5 mm/h (compared with 20.5 or below) was associated with worse survival: HR 2.197 (95% CI 1.318–3.664, p = 0.003). This met the Bonferroni-corrected threshold.
  • In the multivariable analysis, a lymphocyte count above 1.1 × 10^9 per litre (compared with 1.1 or below) was associated with better survival: HR 0.436 (95% CI 0.258–0.737, p = 0.002). This met the Bonferroni-corrected threshold.
  • In the multivariable analysis, age above 65.5 years (compared with 65.5 or below) was associated with worse survival: HR 1.824 (95% CI 1.159–2.872, p = 0.009). This did not meet the Bonferroni threshold and was treated as exploratory.
  • In the multivariable analysis, a platelet count above 289.5 × 10^9 per litre (compared with 289.5 or below) was associated with worse survival: HR 1.802 (95% CI 1.084–2.997, p = 0.023). This result was exploratory.
  • In the multivariable analysis, total protein above 62.9 g/L (compared with 62.9 or below) was associated with better survival: HR 0.625 (95% CI 0.394–0.990, p = 0.045). This result was exploratory.
  • The epithelioid subtype was the most common. The results text reports 82 patients (63.6%) as epithelioid; Table 1 gives 81 (62.8%).
  • Calretinin staining was positive in 103 of the 112 patients tested (92.0%).
  • Among the 109 patients with CT images, 63 (57.8%) had nodular pleural thickening and 70 (64.2%) had moderate pleural effusion.
  • CT features showed no significant correlation with histological subtype.
  • Only six patients had PET-CT. The PET-CT findings are descriptions of example images: an epithelioid case had a maximum tracer uptake (SUVmax) of 2.5, a sarcomatoid case 7.9, and a biphasic case 3.3.
• The authors' conclusion: The authors concluded that age, ESR, lymphocytes, platelets and total protein may be related to the prognosis of malignant pleural mesothelioma patients. They also concluded that combining clinical, pathological, radiological and PET-CT results could improve clinicians' diagnostic accuracy.
• Limitations the authors state:
  • The total population was relatively small despite the study being run at two centers.
  • Selection bias was unavoidable given the study's nature.
  • Patients were enrolled over a long time span, which might affect the results.
  • Missing SUVmax, CRP and pleural effusion data meant that SUVmax, the LENT score, the PROMISE score and other indicators could not be analyzed.
  • The findings for age, platelets and total protein came from exploratory analysis, did not reach the Bonferroni threshold, and need to be replicated.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Prognosis, Pleural Mesothelioma, Histological Subtype, Epithelioid, Sarcomatoid, Biphasic Mesothelioma, Calretinin, Cytokeratin 5/6.

Related studies

• Radiological characteristics, histological features and clinical outcomes of lung cancer patients with coexistent idiopathic pulmonary fibrosis — K.A. Khan, M.P. Kennedy, et al. (2015)
• DNA methylation-regulated HLA-C expression modulates immune responses and metabolic alterations to influence prognosis in mesothelioma — H. Zhang, L. Yu, et al. (2025)
• A Significant Metabolic and Radiological Response after a Novel Targeted MicroRNA-based Treatment Approach in Malignant Pleural Mesothelioma — S.C. Kao, M. Fulham, et al. (2015)
• A clinical, radiographic and laboratory evaluation of prognostic factors in 363 patients with malignant pleural mesothelioma — A.C. Tanrikulu, A. Abakay, et al. (2010)
• p53, p21 and metallothionein immunoreactivities in patients with malignant pleural mesothelioma: correlations with the epidemiological features and prognosis of mesotheliomas with environmental asbestos exposure — R. Isik, M. Metintas, et al. (2001)
• Diffuse mesothelioma of the peritoneum: correlation between histological and clinical parameters and survival in 73 patients — S. Liu, P. Staats, et al. (2014)

Browse more research in Medicina, or return to medical research.